Center lordotic mesh cage

ABSTRACT

An implant assembly including a curved mesh cage and angled endplates. The implant assembly offers a safe and secure mesh cage while providing lordosis/kyphosis angling at the center of the construct instead of at the end of the cage only. One or more angled endplates may be included which allow the surgeon to make a construct unique to the patient&#39;s anatomy. The endplates press-fit into corresponding holes in the mesh cage for a secure fit.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.15/836,362, filed on Dec. 8, 2017, which is a continuation in partapplication of U.S. patent application Ser. No. 15/264,974 filed on Sep.14, 2016, the contents of which are incorporated by reference herein intheir entirety for all purposes.

FIELD

The present disclosure relates to systems and devices for supporting thespine after removal of at least a part of a vertebra. More particularly,the disclosure relates to vertebral body replacement implant assembliesand attachment assemblies.

BACKGROUND

Diseases and injury to bone structures, such as the vertebral column,and conditions requiring surgical intervention are relatively common. Avariety of conventional implant or graft devices are presently availablefor use in specific areas. The devices vary in size, shape, materialsused, and insertion techniques. For example, in the vertebral column,grafts may provide restoration, decompression, or stabilization of thespine. Typically, these devices include a member that is inserted in thevertebral column to replace an injured portion. An example of such aprocedure is a corpectomy, which involves the replacement of all or aportion of the vertebral body with an implant or graft. One exemplarygraft is a mesh corpectomy cage which is secured to the adjacentvertebrae via end plates to maintain the position of the implant insitu.

While these conventional devices may generally provide adequate results,they have several disadvantages. For example, often with a corpectomythat involves more than one level, the center segment of the corpectomycage will settle into a position very close to the patient's dura andspinal cord due to the natural lordosis/kyphosis of the patient. Suchproximity to the dura and spinal cord may cause pain, discomfort orfurther damage to the vertebral column.

Additionally, the endplates are typically secured to the cage withscrews. The screws are often cumbersome to install and also make it moredifficult to safely remove and replace any component of the construct.Furthermore, there is an inherent risk that the screws may be droppedduring a procedure.

SUMMARY

To meet this and other needs, a curved cage with press-fit endplates isprovided. According to one embodiment, an implant assembly forengagement between a first vertebral body and a second vertebral bodyincludes a tubular cage having an outer surface and an inner surface,wherein the cage extends from a first end to a second end, contains aplurality of openings extending from the outer surface to the innersurface, and wherein a longitudinal axis of the cage is curved. Theimplant assembly also includes a first endplate configured to engage thefirst vertebral body and press-fit into the first end and a secondendplate configured to engage the second vertebral body and press-fitinto the second end.

According to another embodiment, an implant assembly for engagementbetween a first vertebral body and a second vertebral body includes amesh cage having a passageway extending from a first end of the cage toa second end of the cage, wherein a plurality of radial openings aredisposed through an outer surface of the mesh cage into the passageway.The implant assembly also includes a first endplate having a firsttapered surface configured to press-fit into the first end and a secondendplate have a second tapered surface configured to press-fit into thesecond end.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated herein and constitutepart of this specification, illustrate the presently preferredembodiments of the disclosure, and, together with the generaldescription given above and the detailed description given below, serveto explain the features of the disclosure. In the drawings:

FIG. 1 is a side elevation view of an implant assembly according to anexemplary embodiment attached between vertebrae.

FIG. 2 is a perspective view of an exemplary cage member of the implantassembly of FIG. 1.

FIG. 3 is a top plan view of the cage member of FIG. 2.

FIG. 4 is a top plan view of an alternative cage member.

FIG. 5 is a top plan view of yet another alternative cage member.

FIG. 6 is an exploded perspective view of the implant assembly of FIG.1.

FIG. 7 is an exploded perspective view of another exemplary implantassembly.

FIG. 8 is a perspective view of the implant assembly of FIG. 7 in anassembled configuration.

FIG. 9 is a cross-sectional view along the line 9-9 in FIG. 8.

FIG. 10 is a perspective view of an exemplary cage member.

FIGS. 11A-11C are perspective views of exemplary endcaps.

FIGS. 12A-12C are perspective views of exemplary endcaps.

FIG. 13A is a top view of an exemplary endcap.

FIG. 13B is a perspective view of an exemplary endcap

FIG. 14A is perspective view of an exemplary implant assembly prior toinstallation of exemplary endcaps.

FIG. 14B is a perspective view of an exemplary implant assembly.

FIGS. 15A-15B are perspective views of an exemplary removal tool.

DETAILED DESCRIPTION

In the drawings, like numerals indicate like elements throughout, withalphabetical or prime identifiers indicating a particular one of themore generally identified element. Certain terminology is used hereinfor convenience only and is not to be taken as a limitation on thepresent invention. The following describes preferred embodiments of thepresent disclosure. However, it should be understood, based on thisdisclosure, that the invention is not limited by the preferredembodiments described herein.

Referring to FIG. 1, an exemplary implant assembly 100 in accordancewith an embodiment of the disclosure is illustrated positioned between apair of vertebrae 10 a, 10 b. The implant assembly 100 generallyincludes two or more mesh cages 102 a, 102 b, at least one intermediateplate 120 and a pair of endplates 140, 160. The intermediate plate 120is secured between the cages 102 a, 102 b and has an angledconfiguration such that the central axis CAa of the cage 102 a is angledat an acute angle α (see FIG. 9) relative to the central axis Cab of thecage 102 b. The endplate 140 is secured to the end of cage 102 a andsecures the cage 102 a to the adjacent vertebrae 10 a. The endplate 160is secured to the end of cage 102 b and secures the cage 102 b to theadjacent vertebrae 10 b. The lordotic angle α created by theintermediate plate 120 helps to align the ends of the cages 102 a, 102 bwith the vertebral endplates 10 a, 10 b which will help in minimizingsubsidence. The lordotic angle α also positions the cages 102 a, 102 baway from the dura 14 and spinal cord 12 of the patient.

Referring to FIGS. 2-5, exemplary embodiments of the cage 102 will bedescribed. Each cage 102 generally has a hollow tubular body 104extending between ends 103, 105 with a passage 106 therethrough. Thetubular body 104 may be manufactured from various materials, forexample, but not limited to, titanium or other metals, carbon fibers,ceramics, polymers or biocomposites. As illustrated in the embodiment ofFIGS. 2 and 3, the exemplary cage 102 has a circular cross-section,however, the cage 102 may have various configurations. As twonon-limiting examples, the cage 102′ illustrated in FIG. 4 has a kidneyshaped cross-section and the cage 102″ illustrated in FIG. 5 has an ovalcross-section. The mesh cages 102 may be supplied at various convenientlengths or can be cut to size. It is understood that the cages 102 a,102 b of the implant assembly 100 may have the same or differentlengths.

The tubular body 104 defines a series of radial openings 108 which openinto the through passage 106. The radial openings 108 facilitate boneingrowth and provide connection points for clips on the intermediateplate 120 and the endplates 140, 160, as will be described in moredetail hereinafter. The openings 108 are preferably evenly spaced aboutthe tubular body 104 to create a mesh thickness that offers compressiveand torsional strength while allowing the cage to be easily cut tolength. While the openings 108 are illustrated with a circularconfiguration, they openings 108 may have other shapes, for example,square or octagon.

Each end 103, 105 of the cage 102 includes a series of end openings 110which open into the through passage 106 and are also open to therespective end surface of the tubular body 104. The end openings 110 areconfigured to receive tabs extending from the intermediate plate 120 andthe endplates 140, 160 to provide rotational stability. While the endopenings 110 are illustrated with a semi-circular configuration, theyopenings 108 may have other shapes, for example, square or octagon, andmay have a depth that is more or less than one-half the width.

Exemplary intermediate plates 120, 120′ and endplates 140, 140′, 160,160′ will be described with reference to FIGS. 6-9. The differencesbetween the components of the implant assembly 100 of FIG. 6 and theimplant assembly 100′ of FIGS. 7-9 will be identified, otherwise thecomponents are substantially the same. With respect to the cages, thecages 102 a′ and 102 b′ are shorter than the cages 102 a and 102 b andhave an oval configuration instead of the round configuration of thecages 102 a and 102 b.

Turning to the intermediate plates 120, 120′, each plate 120, 120′ has aring shaped body 122, 122′ with a passage 127 therethrough. The body 122has a circular configuration to match that of the cages 102 a, 102 bwhile the body 122′ has an oval configuration to match that of the cages102 a′, 102 b′. Each body 122, 122′ extends between opposed contactsurfaces 121, 123. The contact surfaces 121, 123 are at an angle θrelative to one another. This angle θ between the contact surfaces 121,123 creates the lordotic angle α between the central axes CAa and Cab ofthe cages. In the event that more than two cages are utilized,intermediate plates 120 can be positioned between respective cages 102,each with the same or different angles θ.

On each body 122, 122′, a plurality of tabs 124 extend from the contactsurface 121 and a plurality of tabs 126 extend from the contact surface123. The tabs 124, 126 have shapes which complement the shape of the endopenings 110 such that the tabs 124, 126 are received in and engage theend openings 110 of the respective cages 102. Engagement between thetabs 124, 126 and the end openings 110 provides rotational stabilitybetween the intermediate plates 120, 120′ and the cages 102. As seen incomparing the intermediate plate 120 with the intermediate plate 120′,the number and location of tabs 124, 126 may be varied. Additionally,the tabs 124, 126 may be eliminated provided the spring clips 130,described below, provide sufficient rotational stability.

A plurality of spring clips 130 extend from each contact surface 121,123. As seen in comparing the intermediate plate 120 with theintermediate plate 120′, the number and location of spring clips 130 maybe varied. Each spring clip 130 includes a body 132 extending from therespective surface 121, 123 and defining a retaining ledge 134 spacedfrom the respective surface 121, 123. The bodies 132 may have differentlengths to account for the angle between the contact surfaces 121, 123such that each of the retaining ledges 134 on respective side of theintermediate plate 120, 120′ are co-planar. With the retaining ledges134 co-planar, the retaining ledges 134 will engage a common row ofopenings 108 in a respective cage 102 (see FIG. 9). Each spring clipbody 132 is elastic such that it bends inward as spring clips 130 passinto the cage through passage 106, but then springs outward as theretaining ledge 134 aligns with a respective opening 108. The bodies 132may have a tapered end surface to promote the inward bending of thespring clips 130 as they are inserted. The retaining ledges 134 therebyengage the openings 108 and axially secure the intermediate plate 120,120′ to the cages 102. If it is desired to remove the intermediate plate120, 120′ from the cages 102, the retaining ledges 134 are biased inwarduntil they clear the openings 108 and the intermediate plate 120, 120′is easily disconnected.

Turning to the endplates 140, 140′, each plate 140, 140′ has a ringshaped body 142, 142′ with a passage 147 therethrough. The body 142 hasa circular configuration to match that of the cage 102 a while the body142′ has an oval configuration to match that of the cage 102 a′. Eachbody 142, 142′ extends between opposed contact surfaces 141, 143, withthe contact surface 141 being a bone contact surface and the contactsurface 143 being a cage contact surface. The contact surfaces 141, 143of the endplate 140 are at an angle β relative to one another while thecontact surfaces 141, 143 of the endplate 140′ are parallel to oneanother. The endplates 140, 140′ can have an angled or parallelconfiguration. This angle θ, or lack of angle, between the contactsurfaces 141, 143 allows the surgeon to make an implant assembly 100,100′ unique to the patient's anatomy.

On each body 142, 142′, a plurality of projections 144 or the likeextend from the contact surface 141 and are configured to engage thevertebrae contact surface. Various surface configurations may beutilized to achieve a desired securement with the vertebrae contactsurface. Additionally, the body 142 may include radial openings 145which promote bone growth into the endplate 140.

Similar to the intermediate plates, a plurality of tabs 146 extend fromthe contact surface 143. The tabs 146 have shapes which complement theshape of the end openings 110 such that the tabs 146 are received in andengage the end openings 110 of the respective cages 102. Engagementbetween the tabs 146 and the end openings 110 provides rotationalstability between the endplates 140, 140′ and the cages 102. As seen incomparing the endplate 140 with the endplate 140′, the number andlocation of tabs 146 may be varied. Additionally, the tabs 146 may beeliminated provided the spring clips 150, described below, providesufficient rotational stability.

A plurality of spring clips 150 extend from the contact surface 143. Asseen in comparing the endplate 140 with the endplate 140′, the numberand location of spring clips 150 may be varied. Each spring clip 150includes a body 152 extending from the surface 143 and defining aretaining ledge 154 spaced from the surface 143. With the endplate 140,the bodies 152 may have different lengths to account for the anglebetween the contact surfaces 141, 143 such that each of the retainingledges 154 of the intermediate plate 140 are co-planar. With theendplate 140′, the bodies 152 will have a common length such that theretaining ledges 154 are co-planar. With the retaining ledges 154co-planar, the retaining ledges 154 will engage a common row of openings108 in a respective cage 102 (see FIG. 9). Each spring clip body 152 iselastic such that it bends inward as spring clips 150 pass into the cagethrough passage 106, but then springs outward as the retaining ledge 154aligns with a respective opening 108. The bodies 152 may have a taperedend surface to promote the inward bending of the spring clips 150 asthey are inserted. The retaining ledges 154 thereby engage the openings108 and axially secure the endplate 140, 140′ to the cage 102. If it isdesired to remove the endplate 140, 140′ from the cage 102, theretaining ledges 154 are biased inward until they clear the openings 108and the endplate 140, 140′ is easily disconnected.

Turning to the endplates 160, 160′, each plate 160, 160′ has a ringshaped body 162, 162′ with a passage 167 therethrough. The body 162 hasa circular configuration to match that of the cage 102 a while the body162′ has an oval configuration to match that of the cage 102 a′. Eachbody 162, 162′ extends between opposed contact surfaces 161, 163, withthe contact surface 161 being a bone contact surface and the contactsurface 163 being a cage contact surface. In the illustratedembodiments, the contact surfaces 161, 163 of each of the endplates 160,160′ are parallel to one another, however, it is understood that thesurfaces 161, 163 may be angled relative to one another to allow thesurgeon to make an implant assembly 100, 100′ unique to the patient'sanatomy.

On each body 162, 162′, a plurality of projections 164 or the likeextend from the contact surface 161 and are configured to engage thevertebrae contact surface. Various surface configurations may beutilized to achieve a desired securement with the vertebrae contactsurface.

Similar to the intermediate plates, a plurality of tabs 166 extend fromthe contact surface 163. The tabs 166 have shapes which complement theshape of the end openings 110 such that the tabs 166 are received in andengage the end openings 110 of the respective cages 102. Engagementbetween the tabs 166 and the end openings 110 provides rotationalstability between the endplates 160, 160′ and the cages 102. As seen incomparing the endplate 160 with the endplate 160′, the number andlocation of tabs 166 may be varied. Additionally, the tabs 166 may beeliminated provided the spring clips 170, described below, providesufficient rotational stability.

A plurality of spring clips 170 extend from the contact surface 163. Asseen in comparing the endplate 160 with the endplate 160′, the numberand location of spring clips 170 may be varied. Each spring clip 170includes a body 172 extending from the surface 163 and defining aretaining ledge 174 spaced from the surface 163. With each of theendplates 160, 160′, the bodies 172 will have a common length such thatthe retaining ledges 174 are co-planar. With the retaining ledges 174co-planar, the retaining ledges 174 will engage a common row of openings108 in a respective cage 102 (see FIG. 9). Each spring clip body 172 iselastic such that it bends inward as spring clips 170 pass into the cagethrough passage 106, but then springs outward as the retaining ledge 174aligns with a respective opening 108. The bodies 172 may have a taperedend surface to promote the inward bending of the spring clips 170 asthey are inserted. The retaining ledges 174 thereby engage the openings108 and axially secure the endplate 160, 160′ to the cage 102. If it isdesired to remove the endplate 160, 160′ from the cage 102, theretaining ledges 174 are biased inward until they clear the openings 108and the endplate 160, 160′ is easily disconnected.

Upon assembly of the implant assemblies 100, 100′, as illustrated inFIGS. 1 and 8-9, the integrated clips 130, 150, 170 on the intermediateplate and endplates snap into the corresponding holes 108 in the meshcages 102 for a secure fit. The quick clip system makes a secureconstruct while allowing for components to be removed and replaced priorto insertion into the body should the need arise. The intermediate plate120 offers a safe and secure connection to the mesh cages 102 whileproviding lordosis/kyphosis at the center of the construct instead of atthe end of the cage only. This allows for the body of the implantassembly to be moved away from the dura and spinal cord of the patient.

In a further embodiment, FIGS. 10-15B relate to components for animplant assembly 1000 (shown in FIGS. 15A-15B). Implant assembly 1000 issimilar in structure to implant assembly 100 but does not contain, atleast, the intermediate plates as discussed above. In FIGS. 10-15B, acage 1002 generally has a hollow tubular body 1004 extending betweenends 1003, 1005 with a passage 1006 therethrough. The tubular body 1004may be manufactured from various materials, for example, but not limitedto, titanium or other metals, carbon fibers, ceramics, polymers orbiocomposites. Similar to the cage 102, cage 1002 may have a circularcross-section, a kidney shaped cross-section, or an oval cross-sectionas shown in FIGS. 2-5. The cage 1002 may be supplied at variousconvenient lengths or can be cut to size. Cage 1002 is illustrated asbeing curved so that a center section of cage 1002 may be positionedaway from dura and spinal cord as previously discussed with respect tocage 102 shown in FIG. 1.

The tubular body 1004 may define a series of radial openings 1008 whichopen into the passage 1006. The radial openings 1008 may facilitate boneingrowth and provide connection points for endplates 1040, 1060, as willbe described in more detail hereinafter. The openings 1008 arepreferably evenly spaced about the tubular body 1004 to create a meshthickness that offers compressive and torsional strength while allowingthe cage to be easily cut to length. While the openings 1008 areillustrated with a circular configuration, the openings 1080 may haveother shapes, for example, square or octagon.

Each end 1003, 1005 of the cage 1002 includes at least one end opening1010 which opens into the through passage 1006 and is also open to therespective end surface of the tubular body 1004. The end openings 1010are configured to receive a tab 1064 extending from the endplates 1040,1060 to provide rotational stability. While the end openings 1010 areillustrated with a semi-circular configuration, the openings 1010 mayhave other shapes, for example, square or octagon, and may have a depththat is more or less than one-half the width. Endplates 1040 and 1060may be configured to have a tapered end 1062 that allows a tapered leadin point for the endplate 1040, 1060 when inserted into cage 1002.Endplates 1040 and 1060 are configured to press-fit or snap-fit into anend of cage 1002. A final fit may be achieved when an underside of anendplate is flush with an end of cage 1002 and tab 1064, which may be ananti-torsion tab, is seated in a partial hole, such as opening 1010.

The end caps may be angled with optional heights that a surgeon may useto make an implant assembly (e.g., implant assembly 1000) that istailored to a specific patient's anatomy. Endcaps 1040 and 1060 may beaccurately centered to each other and the cage 1002 by means of radialholes 1008 in cage 1002.

As shown in FIGS. 11A-12C, endcaps 1040 (and endcaps 1060) may have avariety of lordotic options that will allow a surgeon to choose an endcap that will closely match the lordosis of the patient. FIGS. 11A-Cillustrate varying angles of endcap 1040. FIGS. 12A-C illustrate varyingheights of endcap 1040. Further, each end cap 1040, 1060 may beavailable in a number of height options. For example, FIG. 12A maycorrespond to a height 1066 of 1.5 mm, FIG. 12B may correspond to aheight 1068 of 3.5 mm, and FIG. 12C may correspond to a height 1068 of5.5 mm. Varying height options may allow a surgeon to quickly remove andreplace an end cap 1040 in the case when an implant assembly 1000 is tooshort or too long. An end cap removal tool 1500 may be supplied tofacilitate the change. For example, as shown in FIGS. 15A-15B, removaltool 1500 may include opposing projections 1502 that are configured in away to enter one of openings 1008 to engage tapered ends 1064 of theapplicable endplate to remove the endplate out of cage 1002.

As shown in FIGS. 13A-13B, an inner geometry 1072 of end cap 1040 may befree of mechanical protrusions, which may allow for a maximum graftwindow for insertion of bone growth material. A top surface of end cap1040 may contain teeth 1074 (with or without a laser etched surface)that may aid implant assembly 1000 to grip a vertebral endplate andpromote bony ingrowth.

These and other advantages of the present disclosure will be apparent tothose skilled in the art from the foregoing specification. Accordingly,it will be recognized by those skilled in the art that changes ormodifications may be made to the above-described embodiments withoutdeparting from the broad inventive concepts. It should therefore beunderstood that this disclosure is not limited to the particularembodiments described herein, but is intended to include all changes andmodifications that are within the scope and spirit of the disclosure asdefined in the claims.

What is claimed is:
 1. A method for implanting an implant assembly,comprising: coupling a first endplate having a first lordotic angle anda first height to a first end of a tubular cage of the implant assembly;coupling a second endplate having a second lordotic angle and a secondheight to a second end of the tubular cage; inserting the implantassembly between a first vertebral body and a second vertebral body,wherein the first endplate is configured to engage the first vertebralbody and the second endplate is configured to engage the secondvertebral body, wherein the tubular cage includes an outer surface andan inner surface, wherein the cage extends from the first end to thesecond end, contains a plurality of openings extending from the outersurface to the inner surface, and wherein a longitudinal axis of thecage is curved.
 2. The method of claim 1, wherein the cage, the firstendplate, and the second endplate have the same cross-sectionalconfiguration.
 3. The method of claim 2, wherein the cross-sectionalconfiguration is one of circular, oval and kidney shaped.
 4. The methodof claim 1, wherein the cage has a length selected from a plurality ofpre-defined lengths or is cut to length.
 5. The method of claim 1,wherein the plurality of openings are radial and open into a hollowpassage traversing the cage along the longitudinal axis.
 6. The methodof claim 5, wherein the first endplate contains an upper surface and alower surface, wherein the lower surface is configured to be tapered toengage the first end of the cage.
 7. The method of claim 6, wherein theupper surface is configured to have at least one protrusion to engagethe first vertebral body.
 8. The method of claim 7, wherein the secondendplate contains an upper surface and a lower surface, wherein theupper surface is configured to be tapered to engage the second end ofthe cage.
 9. The method of claim 8, wherein the lower surface isconfigured to have at least one protrusion to engage the secondvertebral body.
 10. The method of claim 1, wherein the first endplateand the second endplate each comprise one or more tabs configured tolimit torsional movement of the first endplate and the second endplaterelative to the cage, and wherein the one or more tabs of the firstendplate extend towards the second endplate and the one or more tabs ofthe second endplate extend towards the first endplate.
 11. The method ofclaim 1, wherein each of the first height and the second height is oneof 1.5 mm, 3.5 mm, or 5.5 mm.
 12. A method for implanting an implantassembly, comprising: coupling a first endplate having a first lordoticangle and a first height to a first end of a mesh cage of the implantassembly; coupling a second endplate having a second lordotic angle anda second height to a second end of the mesh cage; inserting the implantassembly between a first vertebral body and a second vertebral body,wherein the first endplate is configured to engage the first vertebralbody and the second endplate is configured to engage the secondvertebral body, wherein the mesh cage includes a passageway extendingfrom the first end of the cage to the second end of the cage, wherein aplurality of radial openings are disposed through an outer surface ofthe mesh cage into the passageway, wherein the first endplate and thesecond endplate each comprise one or more tabs configured to limittorsional movement of the first endplate and the second endplaterelative to the cage, and wherein the one or more tabs of the firstendplate extend towards the second endplate and the one or more tabs ofthe second endplate extend towards the first endplate.
 13. The method ofclaim 12, wherein the cage, the first endplate, and the second endplatehave the same cross-sectional configuration.
 14. The method of claim 13,wherein the cross-sectional configuration is one of circular, oval andkidney shaped.
 15. The method of claim 12, wherein the cage has a lengthselected from a plurality of pre-defined lengths or is cut to length.16. The method of claim 12, wherein the cage is curved along alongitudinal axis of the implant assembly.
 17. The method of claim 16,wherein the first endplate contains an upper surface and a lowersurface, wherein the lower surface is configured to be tapered to engagethe first end of the cage.
 18. The method of claim 17, wherein the uppersurface is configured to have at least one protrusion to engage thefirst vertebral body.
 19. The method of claim 18, wherein the secondendplate contains an upper surface and a lower surface, wherein theupper surface is configured to be tapered to engage the second end ofthe cage.
 20. The method of claim 19, wherein the lower surface isconfigured to have at least one protrusion to engage the secondvertebral body.